TUT - Bleeding disorders

Question 1

haemophilia dental implication

Answer 1

• affect approach of haemostasis
• prevention is key to avoid invasive treatment / (matrix band)
• liaise with haemophilia centre
• Consider ABX if tooth unrestorable (A&E case)

Question 2

How would you manage a haemophilia patient who presented to you with an avulsed tooth?

Answer 2

• replant tooth under normal guidance
• phone haemotology (may suggest tranexamic acid)

Question 3

Analgesics for haemphilia pt

Answer 3

• avoid aspirin/ NSADIs
• inhibit platelet aggregation

use paracetamol

Question 4

Why is IDB contraindicated with patients with haemophilia?

Answer 4

• IDB has higher risk of damage to vessels
• local bleed from IDB is not visible and may persist

IA artery/ vein

Question 5

What is the sign of a local bleed from IDB in haemophiliac patients?

Answer 5

Trismus

Question 6

What are the pre-op instructions for XLA in a haemophiliac patient?

Answer 6

• clean mouth
• transexamic acid 1g TID the day prior to XLA and for 6 days after
• NO XLA without prior planning

Question 7

What are the peri-op technique for XLA in an haemophiliac patient?

Answer 7

• chlorhexidine mouth wash for 2 mins prior to LA
• atraumatic XLA technique
• suture socket with surgicel
  +/- vacuum-formed splint
  +/- other haemostatic agents

Question 8

What are the POI for XLA in a haemophiliac patient?

Answer 8

• same as normal
• patient should be monitored for 30-60 mins post op to ensure no re-bleed

Question 9

What demographic is more likely to have haemophilia?

Answer 9

Men as it is a x-linked recessive condition

Question 10

haemophilia A vs B

Answer 10

A: deficiency of clotting factor VIII
B: IX

x-linked hereditary disorder